• The Twisted Story of Asymmetric Spinal Motion

    06 October 2014 / Uncategorized / Comments Off on The Twisted Story of Asymmetric Spinal Motion

    Asymmetric means not symmetric, or unequal. Asymmetry of spinal motion means more movement in some directions than others.

    A physical exam finding of asymmetric spinal motion is a gateway to a Diagnosis-Related Estimate (DRE) class II rating in the The AMA Guides 5th Edition.

    The AMA Guides 5th Edition in Chapter 15 The Spine on page 382 defines asymmetry of spinal motion as “Asymmetric motion of the spine in one of the three principle planes..” But the AMA Guides goes to a little more effort here to help the examiner by stating “To qualify as true asymmetric motion, the finding must be reproducible and consistent and the examiner must be convinced that the individual is cooperative and giving full effort.”

    When documenting asymmetry of spinal motion in an impairment report for rating purposes, it is helpful to the reader if comments on muscle spasm, muscle guarding and employee cooperation are provided. These comments also makes the observation more compelling.

    When reading a report which includes the finding of asymmetry of spinal motion look for comments on muscle spasm, muscle guarding and employee cooperation.

    California PR-4 Reports are about reproducible observations and findings. Reports that are minimally supported may be more confusing than helpful, and lead to costly delay.

  • Exposing the Inclinometer

    22 September 2014 / Uncategorized / Comments Off on Exposing the Inclinometer

    Pronunciation: /ˌinkləˈnämitər

    Besides being fun to say, an inclinometer is nothing more than a fancy level with a protractor on it. The AMA Guides 5th Edition tells us that an inclinometer used by  a physician “should be marked off in 2 degree increments or less..”(Page 400).

    Inclinometers are utilized in medical impairment rating to determine angles of motion, particularly in measuring the spine.

    Because the spine has motion at both the upper and lower segments it's necessary that 2 inclinometers be used simultaneously for recording dynamic motion. One inclinometer is placed at the upper part of the measured spine segment, and the other at the lower spine location. The measurement value of the lower spine is subtracted from the upper spine value. This results in what's known as the “true angle”.

    Inclinometers are either manual and digital.

    Digital inclinometers have been gaining some popularity because of ease of use and automatic calculation of the true angle. Digital inclinometers are two electronic gravity sensors which have ability to standardize a zero measuring reference with the click of a button. They are approximately the size of a pocket-watch and are typically connected by an electronic cord. One end is the measurement reading end (typically referred to as the “master”) placed at the top of the spine. The other device is placed at the lower segment of the spine section (typically referred to as the “slave”). The upside of the digital inclinometer is the ease of use during exam, and it automatically calculates the true angle. The downside is the device may not have an auto off feature.  This means it is easy to leave on, and may be found dead for the next exam. Additionally, digital inclinometers are expensive and can range into the hundreds of dollars.
    The manual inclinometer, sometimes called a “bubble inclinometer” has a fluid filled face in a circle. The fluid is a combination of a colored fluid and a clear fluid. The fluid interface moves with gravity, and the movement of the interface is used to read the measurement off a rotating 360 degree face dial.

    Measuring the motion of the spine with the manual inclinometer requires a bit of practiced talent. The patient is instructed to stand in the upright position and the dial faces are set to the 0 degree position. The user must then hold the two inclinometers at once on the spine while movement is measured. It sounds easy, but in practice for the first several exams, it is difficult. You also must coordinate the physical control of the inclinometer while performing the calculations and documenting the findings. Using the dual manual inclinometers for the first time can be like trying to catch a falling snake. Patience is a virtue and persistence is necessary to capture accurate and consistent measurements.  The upside of the manual inclinometer is that they are relatively inexpensive ($50 each on Amazon as of the writing of this article), and no batteries are necessary. The down side is they do take some practice and can be difficult to read due to the small print face. A good pair of reading glasses may be necessary.

    Regardless of the style of inclinometer used, understanding the inclinometer and its function is essential for accurate and well supported impairment report (PR-4 Report) conclusions. The time invested in becoming familiar with the inclinometer will result in faster and more accurate report for patients, workers’ compensation insurance carriers, employers, and administrators.

    Check out RateFast today and see how easy it is to create accurate, fast and correct PR-4 impairment reports.

  • Work Restrictions Explained

    22 September 2014 / Uncategorized / Comments Off on Work Restrictions Explained

    There’s a lot of misconception confusion and about the terms of use of “work restrictions”, “work capacity” “work tolerance” and.  When we read PR-2, PR-4 or Doctor's First Reports, “work restrictions” tend to be the phrase used most frequently. But is it the phrase that most frequently describes what's going on?

    We’re here to help set the record straight on definitions.

    A Physician’s Guide to Return to Work (Talmage et al., 2005. A Physician’s Guide to Return to Work. AMA Press) offers useful definitions for these terms  to better describe and communicate these concepts.

    Work restrictions are actually the least common of all work limitations encountered. Work restrictions are activities the patient can do, but should not perform because of the risk of significant injury or loss of life. For example,  the patient who has a seizure disorder may have a restriction precluding the driving of a car, because of the possibility of losing control of the vehicle.

    Work capacity is the second  most common of all work limitations encountered. Work capacity refers to a well defined underling medical condition which precludes the patient from performing an activity. In this example a patient with shoulder adhesive capsulitis may demonstrate specific findings on MRI and the condition may also be verified on physical exam testing. For example, the patient may have mechanical limitation preventing motion of the shoulder above 90 degrees. In this situation patient has a medical capacity which limits working at or above shoulder level height.

    Work tolerance is the most common of all work limitations encountered. Tolerance simply means the patient’s symptoms preclude them from participating in certain activities. For example, the employee may have a normal MRI of the shoulder, a normal range of shoulder motion on exam, yet pain symptoms preclude work at or above shoulder level height.

    We understand that the term “work restriction” has become a cultural term used in many administrative forms, however, inappropriate usage causes unnecessary confusion and delay. Begin using the correct terminology for tolerance, capacity and  restriction to more effective communication in reports and correspondence. Your reward will be faster and more accurate results.

  • RateFast and Goliath

    30 August 2013 / California Workers Compensation, Medical History, RateFast / Comments Off on RateFast and Goliath

    Everyone recognizes Michelangelo's statue of David, which today stands proud, tall, and butt naked in the Signoria Accademia Gallery. However, not everyone knows that the carving of Michelangelo's David began before Michelangelo was even born.

    1464, Carrara, Italy. The marble quarry is jagged with the cut away chunks of stone. Miners cart a seventeen foot tall chunk of mountain toward Florence. Within this stone, beneath layer after layer, chip after chip, stands a symbol of fierce pride, culture, and strength.

    Photo credit: Hans Thijs

    The artist Agostino was contracted to make the statue of David, but he abandoned the project for unknown reasons. A decade passed, and Antonio Rossellino was brought in to finish Agostino's work. But Rosselino's involvement was also short lived, and the block of marble was left out in the yard of the Florence Cathedral's workshop, where it weathered the elements for 25 years.

    In 1501, nearly half a century after the project began, 26 year old Michelangelo di Lodovico Buonarroti Simoni outcompeted Leonardo da Vinci and other more experienced artists for the contract to finish the statue of David. After two years of attending to the stone, Michelangelo succeeded in crafting one of the Western culture's most significant works of art.

    Michelangelo's piece shows David prior to fighting Goliath, unlike Donatello's and Verrocchio's statues of David, which show the biblical figure holding the monster's decapitated head, already victorious. Scholars interpret Michelangelo's David as a snapshot of the moment after David has made the decision to fight Goliath, but before actually defeating him.

    The statue, whose stoic face points towards Rome, announces the change coming to a land, a culture, a time. In the world of California Workers' Compensation, RateFast points toward a new future—a future where the efficiency and accuracy of medical legal reports is prioritized, and where doctors, insurance adjusters, and injured workers can rest easily, knowing that their impairment rating is accurate, and incontestable.

    David's confident expression and relaxed posture symbolize RateFast's approach to the Goliath of today's worker's compensation system. You don't need armor and swords to tackle the rules of the A.M.A. guides—a well placed impairment rating, shot from the sling of RateFast, is all that it takes to bring that giant down, and allows everyone to go home early.

    For more information on Michelangelo, visit Artsy.net's wonderfully helpful page on the artist's life and works.

  • RateFast Rides Against MS

    14 August 2013 / California Workers Compensation, RateFast, Uncategorized / Comments Off on RateFast Rides Against MS

    Multiple sclerosis (MS) is not fun. The chronic and crippling disease attacks the nervous system, and can cause paralysis and blindness. According to a certain pharmacist named Dr. Jamie Tobitt, MS often leads to some form of disability. Thankfully, he is taking action.

    On October 19th, 2013, Dr. Tobitt will ride out with his team against multiple sclerosis in the National MS Society's 31st annual MS Bay to Bay Tour, with the RateFast logo rippling above their speeding wheels.

    He and a few thousand other riders will ride a whopping 100 miles through Southern California's notorious heat and beautiful landscape over the course of two days—a good exercise for both the physical and the figurative heart.

    What motivates Dr. Tobitt to embark on this velocipedic odyssey from Orange County to San Diego's Mission Bay? As it turns out, cycling on behalf of MS patients is something of a habit for Dr. Tobitt—this will be his fifth year riding the Bay to Bay.

    "I worked in the MS area and learned how this disease destroys neurons inside patients' brains in the prime of their lives," Dr. Tobitt says. Even though he no longer works in the MS area, he says that he is "inspired by the stories of the patients and their physicians trying to do whatever they can to slow down the disease and hold off disability." He is co-captain of his team, which is called Team Tiki Ha Ha. Most of the team’s members have friends or family members who suffer from or are affected by MS.

    When he's not riding for MS, Dr. Tobitt spends time with his family, listens to David Bowie and The Black Keys, plays jazz trumpet, and works as a Managed Care Liaison in the Medical Affairs department of Vertex Pharmaceuticals.

    "I enjoyed chemistry in high school," Dr. Tobitt recalls. "But I didn't know what a chemist actually did Monday to Friday." His original conception of a career as a pharmacist was "a corner druggist in a small town... maybe with a soda fountain." While in school, he came to understand that a pharmacist is actually an active part of a medical team.

    RateFast is sponsoring Dr. Tobitt and Team Tiki Ha Ha in part because MS is a disease that may eventually leads to impairment or disability.

    But RateFast co-founder Dr. John Alchemy and Dr. Tobitt have been professional and personal friends ever since Dr. Alchemy's medical training at University of California, San Diego. "I am impressed with the idea of RateFast and how Dr. Alchemy has answered an unmet need with a new, unique, and useful tool," Tobitt says. "We are absolutely thrilled to have a sponsorship from RateFast."

  • In Memory of Wesley Artz

    06 August 2013 / California Workers Compensation, Medical Technology, RateFast, Uncategorized / Comments Off on In Memory of Wesley Artz


    Wesley Artz


    RateFast is proud to announce that its first PR-4 impairment rating report is dedicated on the 3.0 version to the memory of Wesley Artz (October 5, 1918 - December 4, 2002), who worked as a precision toolmaker for General Motors.

    The life of the late Mr. Artz is a study in the ideals of accuracy and integrity in workmanship—values that are central to RateFast's mission of producing accurate workers' compensation impairment ratings.

    Wesley Artz is the father of Dr. Jerry Artz, who is a nuclear physicist, a university professor, a ranked tennis player in the Northern division of the USTA (United States Tennis Association), and the programmer responsible for RateFast's ability to take measurement's of a patient's spine, and use the information to generate a precision California workers' compensation impairment rating.

    Dr. Artz's father, Wesley Artz, was born to a farm family of 17 children in Ohio. "My grandfather didn't really see any need for education beyond the 8th grade," Dr. Artz says. Wesley Artz dropped out of school, but eventually he returned after he convinced his father that a high school education was worth having.

    "My dad went to General Motors, and he really established himself as a tool maker," Dr. Artz says. Wesley Artz was uncommonly skilled at his work, which he performed so carefully that General Motors would bring him all of the jobs that required exact measurements. Mr. Artz was the go-to man for projects that required accuracy to "a tenth of a thousandth of an inch," Dr. Artz recalls. Needless to say, such exactitude is hard won, especially in the days before computers.

    Wesley Artz imparted his personal philosophy that a job is not worth doing unless it is done right upon the young Dr. Jerry Artz, who belongs to the first generation of college students in his family. "If my grandfather didn't think that it was important to go to high school, then you can imagine what he thought about college."

    Dr. Artz obtained his B.S. in electrical engineering from the University of Cincinnati, and earned his M.S. from Stanford University in California. After briefly teaching physics at a community college in Washington, he was inspired to pursue his doctoral degree in physics, rather than electrical engineering. He enjoys how physics allows one to delve into pure science and get away from electrical engineering's insistent mantra to "apply, apply, apply." After procuring his Ph.D. in nuclear physics from Florida State University, he did post-doctoral work at the University of Minnesota, and then Notre Dame. Eventually, Dr. Artz returned to Minnesota, and took a tenured teaching position at Hamline University.

    At Hamline, a young man named John Alchemy took Artz's physics class as a Biology major. Years later, John Alchemy became a medical doctor and an impairment rating expert. Dr. Alchemy’s knowledge of the California Workers' Compensation system inspired him to co-create RateFast, the world’s first cloud based comprehensive software impairment reporting platform for the industry’s health professionals.

    Alchemy recalls, “Jerry is one of those rare mentors who teaches content with precision and passion. He gives 200% to his teaching, and is always tireless and patient. He can teach any subject really, it wouldn’t matter. You have no choice but to get excited because he channels so much energy. He is incredibly generous with his most precious resource… time. He does whatever it takes to do the job, a principle underpinning the RateFast design.”

    Remembering his former teacher's penchant for logical challenges and appreciation for precision, Dr. Alchemy called up Dr. Artz in a successful attempt to recruit him for the project of programming software that generates accurate impairment ratings. Alchemy remembers, “I was in a really tough design spot and got Jerry on the phone. I explained to him this incredible challenge and opportunity to put together a program that would create impairment values (AMA Guides to the Evaluation of Permanent Impairment i.e. Whole Person Impairments, WPI) for spine injuries. No one had ever done it, or even attempted to do it to my knowledge. I explained the work would be meticulous, frustrating, lonely, and a Pandora type box of nightmare logic algorithms. The up-side was that this project had the potential to touch the lives of thousands of people in a positive way, and improve a failing system. Basically it was an insane proposal. Jerry was probably the only guy on the planet—other than myself—who was crazy enough to actually try it… and he did it. Anyone else would have buckled under the scope of this project, but not Jerry. Watching him write a logic matrix is like watching a master painter work a canvas. Turns out he thrives on this stuff. At 71 years old, this guy just doesn’t run out of energy.”

    There is a clear harmony of values to be found in the triangulation of Dr. Artz's work as a physicist and programmer, the life of Wesley Artz, and the RateFast mission. The California workers' compensation system is currently framed within the ambiguous and convoluted rules of the AMA Guides, and plagued with inaccurate conclusions. RateFast generates reports that are so consistently accurate that they will eventually set the industry standard for impairment rating accuracy. "That's part of the goal," Dr. Artz says.

    At present, standardized cloud based impairment rating is a young science, but when measurements determine the quality of life for people living with injuries, and the spiraling costs of workers’ compensation insurance premiums for employers, they should be accurate within a tenth of a thousandth of an inch. RateFast intends to bring about that accuracy, not only by bringing a nuclear physicist into the arena, but also by infusing Mr. Wesley Artz's DNA and spirit of precision into a process that is thirsty for greater meticulousness. Look out California Workers’ Compensation, because Mr. Wesley Artz’s is still bringing his “A Game” change to the world.


    Wesley Artz (left) and Jerry Artz (right) fishing


  • NFL image.

    NFL Athletes vs. California

    30 July 2013 / California Workers Compensation, Medical History / Comments Off on NFL Athletes vs. California

    NFL player retires. NFL player suffers from cumulatie trauma—injuries that are incurred gradually over the course of a career spent crunching skulls on the gridiron. NFL player doesn’t want to pay for his injuries out of pocket, but the player has a hard time getting the NFL to pay for his coverage—except in the state of California.

    For a long time, California’s relatively liberal workers’ compensation system has allowed non-Californian professional athletes to get medical coverage, provided that the athletes played games in California at some point during their career. The NFL and other sports leagues don’t like this, because it means that they get stuck with the six-figure cost of treating their players’ injuries, which often last a lifetime.

    Enter Bill AB 1309, which, if approved by the Senate, will prevent prevent out-of-state athletes from using California as a way to get the NFL (or other sports leagues) to pay for their  medical expenses.

    The bill plugs up a leak for professional sports leagues and other businesses to whom California’s workers’ compensation system has been something of an achilles heel.

    Assemblyman Henry T. Perea (D-Fresno), who wrote the bill, said that California’s workers’ compensation system “has been increasingly exploited by out-of-state professional players at the expense of California teams and all California businesses... The flood of claims are raising insurance costs for all employers."

    However, on the other side of the fence, retired athletes and workers’ rights groups oppose the bill. Some maintain that taking away NFL players’ ability to get compensated for injuries partially sustained while in California sets a “dangerous precedent” for denying other workers’ coverage.

    Sarita Gupta, executive director of Jobs with Justice (JwJ), argues that NFL players are entitled to use California’s system provided that they have played a reasonable amount of games and paid taxes in the state.

    According to attorney Dawn Neufield, another AB 1309 antagonist, California’s economy stands to gain from allowing professional athletes to use its workers’ compensation system: “California collected roughly $171 million dollars in taxes from professional athletes last year. So California's economy benefits from these players' taxes, and yet state legislators are still trying to deny them benefits.”

    Here at PR4reports.com and RateFast, our mission is to get fast and accurate impairment ratings for injured workers, not to determine who gets an impairment rating in California and who doesn’t. However, the controversy of AB 1309 raises larger questions about the system that we are attempting to help medical professionals navigate more efficiently. Which California workers qualify as California workers? Where does the line get drawn?

    As of last week, the bill is being fast-tracked. In an attempt to mollify injured athletes who have already applied for workers’ compensation in California, some 6,000 claims that have already been filed will still be processed within the current system. We should be curious about whether or not this batch of claims are the last of their kind in the state.

  • Elementary, my dear Watson!

    25 July 2013 / California Workers Compensation, Chart Reviews, Cloud Based Computing, Impairment Physical Exam, Impairment Rating Specialists, Medical History, Medical Technology / Comments Off on Elementary, my dear Watson!

    There’s a new cloud-based computer service that takes in patient information and then spits out useful results in record time. And no, I’m actually not talking about RateFast. Did you catch the 2011 Jeopardy special where Watson (IBM’s language savvy super-computer) competed against two former Jeopardy champions? The AI system out-answered—or rather, out-asked—both of its human opponents, and won $1 million in prize cash.

    But Watson’s verbal talent is now taking on questions that are tougher than those Alex Trebek would ask: the computer system is diagnosing and generating treatment plans for cancer patients. An agreement between IBM, healthcare company Wellpoint, and Memorial Sloan-Kettering Cancer Center is going to make Watson’s thinking power available to hospitals and clinics around the nation.

    Here’s how it works: you’re a doctor, and you need to write a treatment plan for your patient, but you’re stretched for time, knowledge, resources—or maybe you just want a second opinion. So you log into Watson using an app on your tablet or computer, and you enter your patient’s medical situation. Within minutes—usually within seconds—Watson gives you a series of treatment plans based on the latest medical research, and each plan is ranked by its expected effectiveness and cost.

    Over the past few years, Watson has become an expert oncologist. According to an article at Wired Magazine, Watson needs only a few seconds to search through “600,000 pieces of medical evidence, more than two million pages from medical journals” and 1.5 million patient records. Wellpoint clams that Watson can correctly diagnose lung cancer 90% of the time, as opposed to the relatively paltry 50% correct-diagnosis rate of a human doctor.

    For now, Watson’s expertise is restricted to lung, prostate, and breast cancer, but the computer never stops learning. It’s difficult for doctors to stay abreast of the current medical research in their field, but Watson can “read” the results of new studies as they’re published, and instantly apply the information.

    The Memorial Sloan-Kettering Cancer Center in New York says that it would take 160 hours of reading a week for a doctor to stay current on all new medical knowledge as its published—and that doesn’t even account for applying that knowledge (or taking care of tedious clerical work like filling out PR-4 reports). Obviously, no human medical worker can do what it takes to know everything about their work. But Watson and computer systems like it are unencumbered by the human weakness of, you know, having a life.

    The goal is to have computers crunch numbers and negotiate the rules of today’s labyrinthine healthcare system, while medical professionals can leave work on time. Watson could be a major wave in medical technology’s recent move toward cloud-based apps that aim to streamline productivity around hospitals and clinics.

  • You Just Got Passed By RateFast

    16 May 2013 / California Workers Compensation, Impairment Rating Specialists / Comments Off on You Just Got Passed By RateFast

    Josh Moore's Enduro Bike: Race Fast, with RateFast!

    Joshua Moore, corporate sponsored Enduro racer signs up to race for better impairment rating software.

    A six pack of Northern California’s best beer traded hands.  A gallon of hi test gasoline was procured and added to the deal.  Like that, impairment rating software history was in the making.

    Josh Moore, CPA, and amateur 250cc Enduro class rider, has become RateFast’s first corporate sponsored athlete.

    The deal was formalized later that week on a bar napkin with a sharpie.

    We could all feel the new buzz here at the RateFast team as racer Josh and director John Alchemy penned their names down on the contract. It felt like the revving of a motor, like the thrilling rush of wind as you ride down a steep mountain path….

    Before the first race with the RateFast logo on his bike, I called up Josh Moore and spoke with him about his racing history, and how he got involved with RateFast.

    Josh and John met at the legendary Santa Rosa Accelerated Charter School’s fifth grade trip to Camp Del Oro.  As they were hiking along behind their daughters they realized they had something else in common besides parenthood:  Dr. Alchemy needed an Excel specialist to help with RateFast’s upcoming release, and Josh Moore had an uncanny knowledge of the program.  The two teamed up and haven’t parted ways since.

    Josh started racing motorbikes a few years back, and stepped up his game another notch when he began to look for more people to ride dirt bikes with. I asked him to describe why he likes racing, “It’s like an extreme hike,” he said.  “You get out, go camping, you’re with good people, and you get a little adrenaline rush—it’s just totally fun. “

    This peaked my interest, as I’m an avid hiker, so I had to ask if there were any women in the sport.  He replied, “Some, but not many—there’s a women’s division, they’re out there, and they’re good!” After watching a few dirt-bike racing videos, I was hooked.

    The first race happened a few weeks back. As Josh careened down the sharp turns and steep grades, the RateFast logo was a blur of blue speed passing the other bikes. Like all those doctors still doing worker’s compensation reports without our impairment rating software, the RateFast riding team simply left them in the dust. When I heard about the race I did a small fist pump, thanking that six-pack of beer and gallon of gas—once you RateFast, you never go back.


    P.S. Want a taste of rapid, accurate, impairment rating software? Find out more about RateFast by clicking here: www.rate-fast.com





  • RateFast - The mission: Create correct and rapid impairment reports.

    29 April 2013 / California Workers Compensation, Impairment Rating Specialists / Comments Off on RateFast - The mission: Create correct and rapid impairment reports.

    The RateFast Family: Who We Are

    • Formed by an impairment expert who has been doing reports since 1997, the RateFast team is a group of qualified and experienced professionals who are here to change the world of impairment rating.
    • We hate upfront costs, delays, confusing downloads, and expensive help desks. We’re tired of the current convoluted impairment rating process.
    • We understand how much of your time and money gets wasted on impairment ratings better than anyone. Now you can have a simple solution.

    P.S. Our offer for two free reports is still on! Sign up today to receive your complimentary PR-4 Reports. Visit RateFast.org now!

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